By Teresa Hunt RN,BSN
University of Central Florida
• Infants can’t concentrate urine.
• They achieve complete
bladder control by 4-5 yrs old.
• Most children with acute renal
failure will recover kidney
function.
• Shorter urethras lead to
increase incidence of UTI’s.
• Kidneys function is
proportional to body size.
Function reduced with stress.
• Bladder capacity is 10mL/kg
• Kidney produces:
• Renin – regulate blood
pressure by decreasing
levels.
• Erythropoietin – stimulates
red blood cell production
by the bone marrow.
• Metabolize Vitamin D to its
active form. Necessary for
calcium metabolism
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Holding
Distance to bathroom
Interruption in play
Incomplete emptying
Peers
Overactive bladder
Urgency
Frequency
Picture Citation:
Wikihow. (n.d.) How to manage urinary incontinence in
children. Retrieved 11/15/14
• Affects 15-20% of
children at 5 yrs old and
spontaneously resolve.
• Occurs more often in
families with hx of
bedwetting.
• DDAVP
• Wetting alarm
• Fluid Restrictions
• Avoid extra sugar and
caffeine intake after 4pm
Picture reference:
Lifestyle Theme on Genesis Framework. (2014). Bedwetting. Retrieved Nov
12, 2014.
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Signs and Symptoms
Burning with urination
Frequency and urgency
Fever
Abdominal discomfort
Urine Analysis
• Nitrates, Bacteria, Blood and
WBC’s
• Urine Culture
• >100,000 colonies
• <100,000 colonization
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Causes
Obstruction
Voiding dysfunction resulting
in urinary stasis
Anatomic difference
Individual susceptibility to
infection
Reflux
Sexual activity
Behavioral
• Antibiotics 7-14 days
• Sulfamethoxazole –
Trimethoprim
• Nitrofurantoin
• Cephalosporins
• IM Ceftriaxone
• IV
• Gentamicin
(aminoglycoside)
• Cephalosporin
• Ampicillin
• Girls – wipe front to
back
• Cranberry juice
• Prophylactic antibiotics
• Same as upper left
• Possible circumcision
• Adhesions removal
(penile/vaginal)
• Behavior Modification
Clean- Catch
• Used in children that are
toilet-trained.
• Patient cleans with 3 castile
soaps then pees a little into
the toilet and then pee into
the cup.
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Sterile Catheterization
Used in children (<2yrs)
5Fr or 8Fr
Sterile Technique
Need holding help!
• Issues:
• Girls are “fluffy” and
Urethra and vagina are
closely placed.
• Boys uncircumcised
• Most with grade 1 – 3
will spontaneously
correct without
interventions.
• No resolution, insertion
of Deflux into
submucosa.
• Grade 4 & 5, ureter reimplantation surgery.
• Caused by an
obstruction of the
ureteropelvic junction.
• Fluid backs up into the
kidney. Can be reversed
if obstruction is corrected
or incomplete.
• Increased dilation is
associated with
increased damage
• Hypospadias occurs in
1:250 males.
• Epispadias is very rare.
• May have Chordee.
• May have altered
urinary stream direction.
• Correction not always
needed.
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Picture Reference
Kraft, K.H., Shukla, A.R., and Canning, D.A. [2010]
Hypospadias. Urol. Clin. North Am. 37(2), 167–181.
• Occurs in 4.5% of
normal, healthy boys.
• It can be unilateral or
bilateral.
• Usually spontaneously
corrects by 6 months of
life.
• Found by physical exam.
• Ultrasound 1st
radiological test for UDT
• The surgical process of
moving the testicles down
the vaginal process and
then closing the track.
• Testicles are tacked to
the scrotal area. At
times it can have an
external button to assist
healing and prevent
migration of testicles
• When the testicle rotates
and obstructs blood flow.
• Presents with:
• Severe & progressive pain,
erythema and edema.
• Medical Emergency:
Surgical correction
• Can result in loss of
testicle.
• Determined by
ultrasound
• The infant is born with the
bladder outside of the
body.
• Usually diagnosed in utero.
• Patient maintains kidney
function and may be able
to empty bladder without
catheterizing.
• Surgical correction to be
done at 6-8 weeks of life.
• Collection of fluid that is
isolated to the scrotum.
• Has a bluish hue and
“twinkles” with transillumination.
• Monitor, can self resolve.
• Do not aspirate, surgical
intervention if it does not
resolve.
• (Yu, 2014)
• Tight foreskin, unable to retract.
• Increase change for UTI’s
• Can have ballooning with urination
from trapped urine (see left)
• Usually caused by adhesions to the
glands.
• Balanoposthitis (recurrent infections)
• Poor Hygiene
• Very difficult to catheterize
• Can treat with:
• Betamethasone Cream
• Steroid used for 6-8weeks
BID/TID with foreskin
retractions.
• Circumcision
(Cendron, 2014)
• Very small ureteral opening.
• Occurs with recurrent meatitis from moist environment, prior
hypospadias repair, trauma, and prolonged urethral cath.
• Frequently experience erratic stream, difficult to
initiate stream, UTI’s.
• Surgical correction necessary to open up meatal
opening (Meatotomy). Do not dilate the urethra.
• (Cendron, 2014)
• Nephrolithiasis is the
process of stone formation
• Are the accumulation of
crystals from dietary
minerals in urine.
• Can take up to 4 weeks to
pass. For large stones,
may need surgical
intervention.
• Identified by Ultrasound,
CT (1st choice), Stone
analysis (after passed or
removed, Gold standard)
• (Baggett, 2014)
• Symptoms:
• Dysurina, urinary frequency,
Hematuria, Pain (flank, Lower
abdomen & groin (renal
Colic)), N/V, fever, UTI
• Renal colic comes in waves
and lasts 20-60 min.
• Uncontrolled pain must go
to the ED
• (Baggett, 2014)
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Treatment
INCREASED FLUID INTAKE.
Decreased Salt and eggs.
Medications
• Sodium citrate (increase
urinary pH, HCTZ (decrease
calcium excretion), Antibiotics,
Bladder relaxers (ditropan,
Detrol)
• Surgery:
• Extracorporeal Shock Wave
Lithotripsy (ESWL)
• Ureteroscopy
• Percutaneous
Nephrolithotomy
• Open Stone Surgery
Poststreptococcal
Glomerulonephritis
• Sudden, self-limiting, and fully resolves
• Manifestations:
• Hematuria (cola-colored urine),
Edema (abrupt onset, mild periorbital
or lower extremity), HTN, Proteinuria,
usually young school aged children.
• Labs:
• RBCs, cast, Small Proteinurea (0 –
3+), Altered electrolytes, elevated
blood urea nitrogen or creatinine
levels, Elevated ASO titer or
Streptozyme, decreased complement.
• Management:
• Supportive, Anti-hypertensives and
diuretics, antibiotic treatment for
active streptococcal infection, Low-Salt
diet, Possible fluid restrictions.
Nephrotic Syndrome
• Manifestations:
• Severe Proteinuria (Frothy Urine),
Edema (insidious onset, massive from
shift of fluid into interstitial spaces),
Hypovolemia, Normotensive, Pallor,
Fatigue, Usually toddler or
preschool-age child.
• Labs:
• Protein in urine 3-4+,
Hypoalbuminemia, elevated
cholesterol and triglyceride, H/H,
and PLT levels.
• Management:
• Prednisone, diuretics, possible
albumin administration, prevent
infections and skin breakdown, noadded-salt diet
Nephrotic Syndrome
• Defined as sudden,
severe loss of kidney
function.
• Can be improved once
the underlying condition
can be corrected.
• Manifestations:
• Electrolyte abnormalities,
fluid volume shifts,
increased BUN and serum
creatinine levels, acidbased imbalances, and
nonspecific symptoms such
as poor feeding, decreased
appetite, vomiting, lethargy,
SZ and pallor
• Defined as an irreversible
loss of kidney function that
usually occurs over months
to years.
• Usually caused by
congenital anomalies such
as obstruction, VUR, and
Renal Dysplasia.
• Dialysis or kidney
transplantation when
kidney function is between
5-10%.
• Manifestations:
• Electrolyte abnormalities,
fluid volume shifts
(dehydration or fluid
overload), acid-base
imbalance, renal
osteodystrophy (rickets),
anemia, poor growth, HTN,
fatigue, decreased appetite,
poor feeding, N/V and
neurologic symptoms from
waste accumulation in the
blood.
• Boston Childrens Hospital (2014). Treatment forbladder exstrophy and
epispadias in children. KidsMD Health Topics. Retrieved from
http://www.childrenshospital.org/healthtopics/conditions/b/bladder-exstrophy-and-epispadias/treatments
• Cendron, M. (2014). Circumcision and circumcision revision. Essential
Pediatric Urology for the Pediatric Care Clinician.
Boston Children’s
Hospital Urology Convention.
• Chowdhury, P., Nayak, P., Mallick, S., Gurumurthy, S., Deepak, D.
&
Mossadeq, A. (January-March 2014). Single stage ventral onlay
buccal mucosal graft urethroplasty for navicular fossa stricures. Indian
Journal of Urology. 30 (1). 17-22
• Yu, R. (2014). Module III: Pediatric andrology: Swollen scrotum
(Hydrocele). Essential Pediatric Urology for the Pediatric
Care Clinician. Boston Children’s Hospital Urology
Convention.
• Baggett, A. (2014). What are kidney stones?. Boston Children’s
Urology Department.